Impact of HIE on Public Health Laboratories
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Transcript of Impact of HIE on Public Health Laboratories
Impact of HIE on Public Health Laboratories
What you may not know…
JOINT PUBLIC HEALTH INFORMATICS TASK FORCE
(JPHIT)
HRSA Health Outcome Policy Priority
Improve quality, safety, efficiency and reduce health disparities
Frieden’s Conceptual 5-Tier Public Health Framework
Grizzell’s 6-Tier Model Often Used in Public Health
Traditional Model
(Thomas R. Frieden, MD, MPHAj of PH, April 2010)
Health Information Exchange
HIT: Health Information Technology
Broad terminology for adoption and use of IT in a health setting
EMR vs. EHR
EMR
• HIMSS definition: Component of the electronic health record which is owned by an institution
• Consensus Definition: Comprehensive electronic health record which includes laboratory, pharmacy, clinical and demographic data gathered from all applicable entities (public health laboratories, hospitals, private offices, etc) .
EHR
HIE: Health Information Exchange
The secure transfer of electronic health information such as a medical record from one entity to another place, using electronic messaging such as HL-7
Meaningful Use
Evolving definition to electronically capture in coded format and to report health information and to use that information to track key clinical conditions
HITECH Vision
To improve the health of Americans and the performance of the nation’s health system through health information technology (HIT).
•An important component of health reform
•Harness the full potential of digital technology to prevent and treat illnesses and to improve health.
HITECH Goals
• Improve quality, safety, efficiency, and reduce health disparities
• Engage patients and families
• Improve care coordination
• Ensure adequate privacy & security protections for personal health information
• Improve population and public health
ONC Activities
• Definition of ‘Meaningful Use’ and Setting Standards for Electronic Health Record Incentive Program
• $60M Program to Fund Strategic Health IT Advanced Research Projects
• Health IT "Beacon Communities"
• $80 Million Available to Support Health IT Workforce
• www.healthit.hhs.gov
Pathway to ARRA Incentives
CCHIT-certified or new certifying bodies yet to be named
Stage 1: 25 measures; 17 require only attestation
In either Medicaid or Medicare program
Staged Implementation: Stage 1
• Electronic capture of health information in a coded format
• Tracking key clinical conditions and communicating outcomes for care coordination
• Implementing clinical decision support tools to facilitate medication and disease management
• Reporting for public health purposes.
Staged Implementation
• Stage 2: Builds on stage 1; computerized provider order entry; electronic transmission of diagnostic test results; research
• Stage 3: Builds on stage 3; promotes improvements in quality and safety; patient access and involvement; improved population health data
Implications for public health
• Assess and ensure readiness in several areas:– For 2011, ELR and syndromic surveillance
• Both testing capability of systems to report and actual submissions
• Increase capacity for data management and analysis
• Coordination across programs, state HIT coordinator, state HIE plan, Medicaid, enterprise architecture plan, etc.
Survey of State Health Agencies on Meaningful Use Readiness and
Public Health Informatics Resources
24 respondents 21 responded to funding questions
Survey in the field for three weeks (4/5-4/26)
Distributed to state public health agency Informatics Directors/CIOs or state health officials if no informatics director was designated.
Other-Please Specify
already accept HL7 messages for ELR and syndromic surveillance; ready for Immunization HL7 by Jan 2011
We have implemented an enterprise messaging hub for the exchange of data to/from our agency. We are in the process of implementing additional data exchanges within this infrastructure but have had limited resources to apply.
Responses-Other
Governance, legislation, private sector interests, resources in general
Assistance implementing an EMPI.
More data standards
Which of the following best describes your agencies Technical Assistance needs in preparing for data exchange with Health Information Exchanges and Electronic Health Records? Choose all that apply.
Other-Please specify
Medicaid is part of the state HIT committee
Sharing information, serve on HITE Advisory Comm
Medicaid rep also sits on interagency workgroup, so we are generally aware.
Medicaid not handeled by Dept of Health. Dept of Human Svcs is Medicaid agency.
Medicaid involvement is mostly from the Health Care Facilities surveys end
We are involved as appropriate.
State/territorial Medicaid agencies are required to submit a Medicaid Health IT plan to develop their Medicaid Health IT Infrastructure. How would you describe the public health agency’s interactions with Medicaid planning activities?
Other-Please specify
wide array of systems will make for a challenging implementation
Lack of CDC/HHS /ASTHO & CSTE guidance to states
Public Health IT Funding Needs
Of 21 states that described their resource needs:o States need an average of $1.55 million per year,
with a median of $1.2 million• Range: $85,000-$3,200,000• 25th percentile $505,000• 75th percentile $2,350,000
Category needs (yearly average):• Informatics staff, $325,000• IT staff, $380,000• Program staff, $290,000• IT Systems, $555,000
– One-time needs: Hardware, $315,000
Grant Programs in HITECH
HHS Secretary Shall Establish Programs of:
oGrants to states to promote health IT (emphasizing health information exchange)
o Implementation Assistance and Education of IT workforce
KY HIECC
Implement secure and interoperable statewide e-health network
Improve quality and efficiency of KY Health Care System
6 KY-HIECC Committees
Privacy and SecurityInteroperability and StandardsBusiness Development and FinanceAccountability and transparencyProvider Adoption and Meaningful UsePopulation Health
Potential Value of KHIE to PH
More timely and complete delivery and receipt of disease reports (provider specific or federal partners)
Faster transmission of better information to case managers
Efficient Syndromic SurveillanceEnhance communication with selected
provider and patient populations
Implications for Public Health
• Unprecedented opportunity to partner on HIE and population health improvement– Funding, policy and regulations are aligned– Private and public sector buy-in
• Expectations for public health capabilities around HIE will increase.
Implications for Public Health
• Opportunity to work with CDC and other federal partners to align funding streams with HITECH priorities
• Opportunity to explore certification of public health information systems– CCHIT-like modular certification around MU
requirements, or around broader PHIN requirements?
Laboratory Medicine’s Role
Socioeconomic Factorso Narrowing poverty gap shows
• Cleaner water
• Cancer screening
• Air quality screening
• Vaccination screening
Choosing Good Health w/Public Health Assistance• Analyzing fluoridation in water
• Environmental lead testing and asbestos
• Food testing
Confirming Protective Interventions• Immunization monitors
• Colonoscopy evaluations
Traditional Laboratory Applicationso Cardiovascular Analysis
• Lipids – Cholesterol
• Hemoglobin A1C – Medication Compliance
Education o Benefits of screening
• HIV
• TB
• Rubella
• Hepatitis
HIT in Hospitals
(Jha et al., NEJM 2009)
Lab Results
• Hospitals only (2011)
• Content: HL:7 2.5.1
• Vocabulary: LOINC v2.27, when such codes were received within an electronic transactions from a laboratory
• MU Measure: Hospitals must perform at least one test of EHR capacity to send if the PH entity has the capacity (2011)
Laboratory Objective and Measure
Incorporate lab test results into EHR as structured data
At least 50% of clinical lab tests results are in a certified EHR technology as structured data
LIS requirements to enable medical data exchange
• HL-7 ready?
• Nationally accepted codes (LOINC codes)
LOINC Codes
LIS requirements to enable medical data exchange
• Mappings local codes to LOINC codes
• RELMA
• SNOMED
• National Library of Medicine
RELMA
LIS requirements to enable medical data exchange
• Communication
• Central hub concept (Health Information Exchange)
Communication